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Objective: Our objectives were to describe sociodemographic characteristics associated with the purchase of 1) any fruit drinks and 2) fruit drinks with specific front of package (FOP) nutrition claims. Design: Cross-sectional Setting: United States Subjects: We merged fruit drink purchasing data from 60,712 household-months from 5,233 households with children 0-5y participating in Nielsen Homescan in 2017 with nutrition claims data. We examined differences in predicted probabilities of purchasing any fruit drinks by race/ethnicity, income, and education. We constructed inverse probability (IP) weights based on likelihood of purchasing any fruit drinks. We used IP weighted multivariable logistic regression models to examine predicted probabilities of purchasing fruit drinks with specific FOP claims. Results: One third of households with young children purchased any fruit drinks. Non-Hispanic (NH) Black (51.6%), Hispanic (36.3%), lower-income (39.3%), and lower-educated households (40.9%), were more likely to purchase any fruit drinks than NH White (31.3%), higher-income (25.8%), and higher-educated households (30.3%) (all p Conclusions: We found a higher likelihood of fruit drink purchases in lower-income, lower-educated, NH Black, and Hispanic households. Experimental studies should determine if nutrition claims may be contributing to disparities in fruit drink consumption.

BACKGROUND: Consumption of sugar-sweetened beverages, including fruit drinks (i.e., fruit-flavored drinks containing added sugar), contributes to childhood obesity. OBJECTIVES: We aimed to examine whether nutrition-related claims on fruit drinks influence purchasing among parents and lead to misperceptions of healthfulness. METHODS: We conducted an experiment in a virtual convenience store with 2219 parents of children ages 1–5 y. Parents were randomly assigned to view fruit drinks displaying 1 of 3 claims (“No artificial sweeteners,” “100% Vitamin C,” and “100% All Natural”) or no claim (i.e., control group). Parents selected among each of 2 drinks for their young child: 1) a fruit drink or 100% juice (primary outcome), and 2) a fruit drink or water. RESULTS: When choosing between a fruit drink and 100% juice, 45% of parents who viewed the fruit drink with the “No artificial sweeteners” claim, 51% who viewed the “100% Vitamin C” claim, and 54% who viewed the “100% All Natural” claim selected the fruit drink, compared with 32% in the no-claim control group (all P 0.05). CONCLUSIONS: Nutrition-related claims led parents to choose less healthy beverages for their children and misled them about the healthfulness of fruit drinks. Labeling regulations could mitigate misleading marketing of fruit drinks. This trial was registered at clinicaltrials.gov as NCT04381481.

Objective:To estimate the prevalence of online grocery shopping in a nationally representative sample and describe demographic correlates with online grocery shopping.Design:The Nielsen COVID-19 Shopper Behavior Survey was administered to a subset of Nielsen National Consumer Panel participants in July 2020. We used survey weighted-multivariable logistic regression to examine demographic correlates of having ever online grocery shopped.Setting:Online survey.Participants:18 598 Nielsen National Consumer Panel participants in the USA.Results:Thirty-nine percent of respondents had purchased groceries online, and among prior purchasers, 89 % indicated that they would continue to online grocery shop in the next month. Canned/packaged foods were the most shopped for grocery category online, followed by beverages, fresh foods and lastly frozen foods. In adjusted analyses, younger respondents (39 years or less) were more likely (47 %) to have ever shopped for groceries online than older age groups (40–54 years, 55–64 years and 65+ years) (29 %, 22 % and 23 %, respectively, all P < 0·001). Those with greater than a college degree were more likely to have ever grocery shopped online (45 %) than respondents with some college education (39 %) and with a high school education or less (32 %) (both P < 0·001). Having children, having a higher income and experiencing food insecurity, particularly among higher income food-insecure households, were also associated with a higher probability of prior online grocery shopping.Conclusions:The COVID-19 pandemic accelerated the transition to online grocery shopping. Future research should explore the nutrition implications of online grocery shopping.

During the COVID-19 pandemic, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash Value Benefit (CVB) for fruits and vegetables increased by roughly USD 25/month/person. We sought to understand WIC participant perceptions of this change and barriers and facilitators to using the CVB. We conducted 10 virtual focus groups (5 rural, 5 urban/suburban) with WIC participants (n = 55) in North Carolina in March 2022. Focus groups were recorded and transcribed. We open-coded the content and used thematic analysis to uncover consistencies within and between sampled groups. Participants expressed favorable perceptions of the CVB increase and stated the pre-pandemic CVB amount was insufficient. Barriers to using the increased CVB were identifying WIC-approved fruits and vegetables in stores and insufficient supply of fruits and vegetables. Barriers were more pronounced in rural groups. Facilitators of CVB use were existing household preferences for fruits and vegetables and the variety of products that can be purchased with CVB relative to other components of the WIC food package. Participants felt the CVB increase allowed their families to eat a wider variety of fruits and vegetables. The CVB increase may improve fruit and vegetable intake, particularly if made permanent, but barriers to CVB and WIC benefit use may limit the potential impact.

During the COVID-19 pandemic, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash Value Benefit (CVB) for fruits and vegetables increased by roughly USD 25/month/person. We sought to understand WIC participant perceptions of this change and barriers and facilitators to using the CVB. We conducted 10 virtual focus groups (5 rural, 5 urban/suburban) with WIC participants (n = 55) in North Carolina in March 2022. Focus groups were recorded and transcribed. We open-coded the content and used thematic analysis to uncover consistencies within and between sampled groups. Participants expressed favorable perceptions of the CVB increase and stated the pre-pandemic CVB amount was insufficient. Barriers to using the increased CVB were identifying WIC-approved fruits and vegetables in stores and insufficient supply of fruits and vegetables. Barriers were more pronounced in rural groups. Facilitators of CVB use were existing household preferences for fruits and vegetables and the variety of products that can be purchased with CVB relative to other components of the WIC food package. Participants felt the CVB increase allowed their families to eat a wider variety of fruits and vegetables. The CVB increase may improve fruit and vegetable intake, particularly if made permanent, but barriers to CVB and WIC benefit use may limit the potential impact.

Objective:Sugar-sweetened beverage (SSB) consumption in early childhood is a public health concern. Adequate hydration in early childhood is also important. We developed a national research agenda to improve beverage consumption patterns among 0–5-year-olds. This article focuses on the process used to develop this research agenda.Design:A mixed methods, multi-step process was used to develop the research agenda, including: (i) a scientific advisory committee; (ii) systematic reviews on strategies to reduce SSB consumption and increase water access and consumption; (iii) two stakeholder surveys to first identify and then rank strategies to reduce SSB consumption and increase water access and consumption; (iv) key informant interviews to better understand determinants of beverage consumption and strategies to improve beverage consumption patterns among high-risk groups; (v) an in-person convening with experts; and (vi) developing the final research agenda.Setting:This process included research and stakeholders from across the United States.Participants:A total of 276 participants completed survey 1 and 182 participants completed survey 2. Key informant interviews were conducted with 12 stakeholders. Thirty experts attended the convening, representing academia, government, and non-profit sectors.Results:Thirteen key issue areas and 59 research questions were developed. Priority topics were beverage consumption recommendations, fruit-flavoured drink consumption, interventions tailored to high-risk groups, and family engagement in childcare.Conclusions:This research agenda lays the groundwork for research efforts to improve beverage patterns of young children. The methods used can be a template to develop research agendas for other public health issues.

OBJECTIVES: COVID-19 has created a new normal, affecting food purchasing behaviors, moving a portion of them online. It is unknown how these behavioral shifts may differ by sociodemographic characteristics and whether shifts may widen or diminish existing diet-related disparities. To fill these gaps, we use nationally-representative Consumer Panel survey data to examine shifts in online grocery shopping by sociodemographic characteristics. METHODS: The Nielsen COVID-19 Shopper Behavior Survey was administered to a subset of Nielsen Homescan panel participants in March-April 2020 (n = 17,262 households (HH)). We describe survey-weighted HH sociodemographic characteristics and reasons for online shopping. Survey weighted-multivariable logistic regression was used to examine sociodemographic correlates of reported increases in online food shopping. RESULTS: One third (34%) of our survey-weighted sample said they shopped for groceries online more since COVID-19, and 60% of these HH reported planning to continue shopping online after COVID-19. In adjusted analyses, all age groups (40–54 y, 55–64y, 65 + y) had lower odds of online shopping than heads of HH 39 years or younger (all OR = 0.7, P

For the first time, the 2020–2025 Dietary Guidelines for Americans include recommendations for infants and toddlers under 2 years old. We aimed to create a diet quality index based on a scoring system for ages 12 to 23.9 months, the Toddler Diet Quality Index (DQI), and evaluate its construct validity using 24 h dietary recall data collected from a national sample of children from the Feeding Infants and Toddlers Study (FITS) 2016. The mean (standard error) Toddler DQI was 49 (0.6) out of 100 possible points, indicating room for improvement. Toddlers under-consumed seafood, greens and beans, and plant proteins and over-consumed refined grains and added sugars. Toddler DQI scores were higher among children who were ever breastfed, lived in households with higher incomes, and who were Hispanic. The Toddler DQI performed as expected and offers a measurement tool to assess the dietary quality of young children in accordance with federal nutrition guidelines. This is important for providing guidance that can be used to inform public health nutrition policies, programs, and practices to improve diets of young children.

Objectives:Toddler milk (i.e. a nutrient-fortified milk-based drink marketed for children 12–36 months old) is increasingly being marketed in the USA despite not being recommended for young children. There is evidence of targeted toddler milk marketing to Latinos in the USA. This study aimed to explore toddler milk perceptions and behaviours among Latino and non-Latino parents.Design:An online survey assessed toddler milk perceptions, behaviours and interpretations of nutrition-related claims. Multivariable logistic and linear regression explored socio-demographic correlates of parent reported past purchases and perceived healthfulness.Setting:Online.Participants:National convenience sample of 1078 US parents of children aged 2–12 years (48 % Latino).Results:About half of parents (51 %) had previously purchased toddler milk and few (11 %) perceived toddler milk as unhealthy. Latino parents were more likely to have purchased toddler milk than non-Latino parents (P< 0·001), but there were no differences in perceived product healthfulness (P= 0·47). Compared to parents born in the USA, parents living in the USA 10 years or less were more likely to have purchased toddler milk (P< 0·001) and perceive toddler milk as healthier (P= 0·002). Open-ended interpretations of claims were primarily positive, suggesting ‘health halo’ effects.Conclusions:Common misperceptions about toddler milk healthfulness suggest stronger labelling regulations are needed. Greater reported purchases by Latino parents and recent immigrants warrant further investigation.

Young children regularly consume sugary fruit drinks, in part because parents may falsely believe they are healthful due to front-of-package (FOP) claims and imagery. The goal of this study was to assess: 1) the prevalence of FOP claims/imagery on fruit-flavored beverages purchased by U.S. households with 0-5-year-olds, and 2) proportional differences in beverages purchased with FOP claims/imagery across household demographic groups. A content analysis of FOP claims/imagery (e.g., nutrient claims, fruit imagery) on beverages (n = 1365) purchased by households with 0-5-year-olds was conducted by linking beverage sales with FOP marketing data. Results were merged with purchasing data from a nationally representative sample of households (FoodAPS), and survey-weighted logistic regression was used to assess differences in the proportions of 100% juices and fruit drinks with specific FOP claims/imagery purchased by household race/ethnicity, income, and SNAP/WIC participation. The most common claims on fruit-flavored beverages included nutrient claims (fruit drinks: 73%; 100% juices: 68%; flavored waters: 95%), which most commonly highlighted vitamin C (35-41% across beverage categories) and the absence of sugar (31-48%). Most beverages also contained implied-natural claims (fruit drinks: 60%; 100% juices: 64%; flavored waters: 95%) and natural imagery (fruit drinks: 97%; 100% juices: 96%; flavored waters: 73%). A large proportion of fruit drinks and 100% juices purchased by households across all demographic groups contained FOP claims and imagery, with a few minor differences between racial/ethnic groups. In conclusion, most fruit drinks, 100% juices, and flavored waters purchased by households with 0-5-year-olds contained FOP claims and imagery that may lead consumers to believe the beverages are healthy and natural. FDA regulations should ensure parents are not misled by this marketing.

BACKGROUND. Toddler milk (ie, a nutrient-fortified milk-based drink marketed for children aged 12 to 36 months) has been increasingly marketed in the United States with structure/function claims on product packaging that are potentially misleading. OBJECTIVE. This study examined how structure/function claims impact parents’ beliefs and perceptions about a toddler milk product. DESIGN. This was a 3-arm between-subjects randomized experiment. PARTICIPANTS. Diverse sample of 2,190 US parents of children ages 1–5 for an online survey. INTERVENTION. Participants were randomly assigned to view a toddler milk package with either an unrelated claim (“new and improved”, i.e., control condition), a “brain development” claim (i.e., “brain” claim), or an “immunity-related” claim (i.e., “immunity” claim). MAIN OUTCOME MEASURES. Outcomes included perceptions, intentions, and beliefs about the toddler milk product. STATISTICAL ANALYSES PERFORMED. Linear regression for continuous outcomes and logistic regression for dichotomous outcomes. RESULTS. Parents who were exposed to the “brain” claim or the “immunity” claim were more likely to incorrectly believe that the toddler milk was as healthy or healthier than cow’s milk, compared to those who saw the control claim (89% for “brain” claim, 87% for “immunity” claim, and 79% for control, p

Background Fruit drinks are the most commonly consumed sugar-sweetened beverage among young children. Fruit drinks carry many nutrition-related claims on the front of package (FOP). Nutrition-related claims affect individuals’ perceptions of the healthfulness of products and purchase intentions, often creating a “health halo” effect. Objective The aims of this study were to describe the prevalence of FOP nutrition-related claims on fruit drinks purchased by households with young children and to examine the association between claims and the nutritional profile of fruit drinks. Design The sample included 2059 fruit drinks purchased by households with children 0 to 5 years old participating in Nielsen Homescan in 2017. FOP labels were obtained from 2 databases that contain bar code–level information on all printed material on product labels. A codebook was used to code for presence of FOP nutrition-related claims. The coded claims data were linked by bar code with Nutrition Facts label data. Claim type prevalence was calculated, and the association between claim types and median calories and total grams of sugar per 100 mL was analyzed using Wilcoxon rank-sum tests. The percentages of products containing noncaloric sweeteners (NCSs) with and without each claim type were also calculated and compared. Results Almost all (97%) fruit drinks sampled had at least 1 nutrition-related FOP claim. Implied natural claims such as “natural flavors” were the most common (55% of products), followed by claims about the presence of juice or nectar (49%). Claims about vitamin C (33%), sugar (29%), and calories (23%) were also common. Fruit drinks with vitamin C, juice or nectar, fruit or fruit flavor, and overt natural claims were higher in calories and sugar and less likely to contain NCSs compared with products without these claims. Fruit drinks with calorie, sugar, NCS, implied natural, and other claims were lower in calories and sugar and more likely to contain NCSs compared with products without these claims. Conclusions Claims are prevalent on fruit drinks purchased by households with young children. This is concerning given prior research demonstrating that claims can mislead consumers. Regulatory actions such as requiring a warning or disclosure on drinks that contain added sugars or NCSs should be considered.

A healthy diet is central to health and well-being throughout life. The United States and many other countries are undergoing an obesity epidemic and experiencing serious diet-related health problems. There exists a misalignment and wide gap between national dietary recommendations and dietary patterns of Americans, and thus, a need to find new ways to improve diet and nutrition. This article posits that nutrition education combined with policy, systems, and environmental (PSE) change approaches is more effective than either strategy in isolation and both are needed to reduce the global burden of diet-related chronic diseases. This article presents a conceptual framework for understanding the multiple influences on what people eat; discusses the need for PSE strategies to augment direct nutrition education approaches; and highlights examples of synergistic and promising linkages between nutrition education and PSE strategies in 3 areas: federal nutrition assistance programs, food retail settings, and nutrition and calorie labeling. In addition, future directions where this synergistic approach holds promise for improving population health and reducing health inequities are discussed. Nutrition education combined with PSE changes at governmental and community levels, as well as strategic public-private alliances have the potential to change the way people eat and improve health and well-being.

The Feeding Infants and Toddlers Study (FITS) is the largest survey of dietary intake among infants and young children in the United States. Dietary patterns in early childhood are a key component of prevention of diet-related chronic diseases, yet little is known about how food consumption patterns of infants and young children have changed over time. The objective of this study is to examine trends in food and beverage consumption among children ages 6&ndash, 23.9 months using data from the FITS conducted in 2002, 2008, and 2016. A total of 5963 infants and young children ages 6&ndash, 23.9 months were included in these analyses. Food consumption data were collected using a multiple-pass 24-h recall by telephone using the Nutrition Data System for Research. Linear trends were assessed using the Wald&rsquo, s test in a multivariable linear regression model. Positive significant findings include increases in breast milk consumption and decreases in the consumption of sweets, sugar-sweetened beverages, and 100% fruit juice. More troubling findings include decreasing infant cereal consumption, stagnant or decreasing whole grain consumption, and stagnant consumption of vegetables. Our findings suggest some promising improvements in dietary intake among infants and toddlers in the United States over the past 15 years, but further policy, programmatic, and industry efforts are still needed.

OBJECTIVES: Fruit drinks are a top source of added sugars among US children and carry misleading nutrition claims. Disparities exist in food label use and fruit drink (FD) consumption. We aimed to describe household (HH) demographic characteristics associated with purchase of 1) any FDs and 2) FDs with specific nutrition claims among HH with children 0–5 y. METHODS: We merged HH monthly-level FD purchasing data from 2017 Nielsen Homescan (n 60,712) with product-level nutrition claims data. For our first aim, we examined differences in predicted probabilities of purchasing any FDs by HH race/ethnicity, income, and education. In aim 2, to account for observed differences in likelihood of purchasing any FDs by demographic characteristics, we constructed inverse probability (IP) weights based on each HH's likelihood of purchasing any FD. We then used IP weighted multivariable logistic regression models to examine differences in predicted probabilities of purchasing FDs with specific claims by demographic characteristics, holding the likelihood of purchasing any FDs constant. We used the Holm method to adjust for multiple comparisons. RESULTS: One in three HH with young children purchased any FDs. Non-Hispanic (NH) Black (52%), Hispanic (36%), low-income (39%), and low-educated HH (41%) were more likely to purchase any FDs than NH white (31%), high income (26%) and high educated HH (30%) (all p

Marketing of toddler milk (i.e., typically sugar-sweetened nutrient-fortified milk-based drinks marketed for children 12–36 months) is an emerging public health problem in the US. The American Academy of Pediatrics recommends against the consumption of toddler milk because it often contains added sugar and can displace nutrient-dense foods. Studies have not examined toddler milk perceptions among Latinos, an important gap given Latino children in the US are at high risk of having poor diet quality, and toddler milk is extensively advertised on Spanish-language TV. This study used an online survey of a convenience sample of 58 Latino parents to examine parents’ experiences with toddler milk, understand their perceptions of the healthfulness and the nutrition-related claims on toddler milk, and describe their exposure to toddler milk advertising. Nearly half (44%) of parents in the sample reported purchasing toddler milk. When asked to provide open-ended interpretations of claims on toddler milk, almost all parents gave positive answers, suggesting potential “health halo” effects of the claims. More than half (56%) of parents reported seeing toddler milk advertisements, most commonly on Spanish-language TV. The misperceptions about toddler milk identified should be explored in further research using larger, more representative samples.